Abstract

Background

Estimates place the number of refugees in Nairobi over 100,000. The constant movement
of refugees between countries of origin, refugee camps, and Nairobi poses risk of
introduction and transmission of communicable diseases into Kenya. We assessed the
care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban
refugees.

Methods

During July and August 2010, we conducted a Health Utilization Survey in Section II
of Eastleigh. We used a multistage random cluster sampling design to identify households
for interview. A standard questionnaire on the household demographics, water and sanitation
was administered to household caretakers. Separate questionnaires were administered
to household members who had one or more of the illnesses of interest.

Results

Of 785 households targeted for interview, data were obtained from 673 (85.7%) households
with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported
acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever
in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior
to the survey. Children <5 years old had the highest frequency of all the illnesses
surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported
fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for
each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported
among all age groups of those who sought care. Among participants who reported ≥1
illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health
care services from private health care providers. Fifty-five (18.9%) participants
seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%])
sought care at government-run facilities, and 24 (8.2%) sought care from a relative,
a religious leader, or a health volunteer. Of those who did not seek any health care
services (99 [23.0%]), the primary reason was cost (44.8%), followed by belief that
the person was not sick enough (34.6%).

Conclusion

Health care utilization in Eastleigh is high; however, a large proportion of residents
opt to seek care at private clinics or pharmacies, despite the availability of accessible
government-provided health care services in this area.